Sunday, April 10, 2011

NewFNP has previously discussed the lady scourge of urinary incontinence. Kegels, ladies, kegels!! But what newFNP hasn't talked about is the sister scourge of pelvic organ prolapse.

NewFNP is super content to leave her lady-junk all up in there, where it's supposed to be. Except the parts that are supposed to be outside. They can stay there. NewFNP is just saying this -- a reasonable expectation for aging is to keep all yo junk in its O.G. spot. Let's get Suzanne Somers to work on this one with her team of experts!

Because when innies become outties, that is not so good.

What makes newFNP think of this on a lovely Sunday is a patient who came in with a chief complaint of feeling something falling out of her vagina. This is the second CC of this nature, but as this patient was in her 50's and was not in the post-partum period, newFNP was certain that she would not find any form of placental treasure upon examination.

What newFNP did see was a fairly obvious cystocele-rectocele combination platter. As newFNP's patient had mentioned that the sensation of fullness was more pronounced when she was using force, newFNP went ahead and had her patient give her a little Valsalva while in the lithotomy position.

Had newFNP been wearing 3D glasses, she might have had a heart attack. "Okay, stop!" she told her patient, fearful that she would deliver her uterus into newFNP's hands.

NewFNP quickly completed the OB/GYN referral and was ready to end the visit when her patient asked her, "Is that happening because I'm not having any sexercise?"

"Did you say 'sexercise'?" newFNP replied.

She had indeed.

Not so much a lack of sexercise, no, but her four >8 pound babies delivered vaginally might perhaps be a more likely culprit. (Or, in other cases, family history. Or obesity. Or hysterectomy.)

This blog is for new NPs or NP students who want some real 411 on the life of a new practitioner. A new practitioner in a busy, understaffed, urban community health clinic in a major metropolitan area. Oh, and newFNP swears while writing and, sometimes, while working although she tries to keep those swears to herself. Consider yourself warned.